How Kasich proposals could affect Valley's health departments

Ohio Gov. John Kasich recently unveiled his proposed budget for 2014-2015. The budget contains extensive changes for local health departments that would be mandated if the budget is approved. Those mandates will change how local health districts receive their funding, require local health departments to consolidate resourc...

On any given day, the New Philadelphia Health Department waiting room might be filled with young mothers taking their small children in for an immunization, individuals seeking blood screenings, and men and women getting tested for sexually transmitted diseases.

With just six employees, two of whom are part-time, the city’s health department serves a population of more than 17,000 people. While some may not take advantage of the clinic, the general population is served by the registered sanitarian’s efforts to ensure the food in local grocery stores and restaurants is safe for consumption.

“The needs of our residents are high,” said New Philadelphia’s Health Commissioner Vickie Ionno. “We do meet the core public health capabilities and we do a good job at it.”

But Ionno is concerned about the future of the services the city health department provides. Ohio Gov. John Kasich recently unveiled his proposed budget for 2014-2015. The budget contains extensive changes for local health departments that would be mandated if the budget is approved. Those mandates will change how local health districts receive their funding, require local health departments to consolidate resources such as payroll and human resources, and require departments to pursue accreditation and certain employees to pursue certifications.

“The problem is there are all these things being mandated and there’s no financial help,” Ionno said.

She’s not alone in her concerns. Her concerns are shared by the health commissioners who head Tuscarawas, Carroll, Columbiana, Holmes and Wayne counties, all of whom are part of a northern rural Appalachian Alliance.

THE PLAN

Kasich’s proposals would encourage sweeping changes in the realm of public health. By July of 2014, local departments would be expected to share services such as human resources, payroll processing, information technology and financial management with other departments in the region. Failure to comply will be noted in distribution of grants.

“The goal of regional shared services is to further encourage all local health departments to identify particular areas of need and better connect with departments already having areas of sufficient capacity to assist,” said Ohio Department of Health spokesman Robert Jennings. “For example, sharing of IT services, computers, server space and software group purchasing would yield marked improvements and less cost at the local level. In short, dollars saved will benefit taxpayers.”

Grant administration will change as well. Instead of nearly 400 subgrants, the number will be reduced to a smaller and more manageable number to target various health areas such as sexually transmitted diseases and HIV; Healthy Communities; dental sealants; immunization action plans and injury prevention, Jennings said.

These grants would go to regional hubs that would then disburse the funding to the local health districts. The number of regional hubs haven’t been established yet, Jennings said.

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Kasich’s proposals also require all health departments be ready for accreditation by 2018.

Food sanitarians would also need to be certified by the United States Food and Drug Administration. Jennings said the certification would enhance the sanitarians’ education in food safety, handling and inspection. He said ODH will assist with training, so the only expense should be time and travel.

The volunteer board members also would be required to attend a mandatory eight hours of training for public health. Jennings said the education would be free or of minimal cost and cover topics such as open records and sunshine laws.

The health commissioner also would be responsible for developing a comprehensive community assessment for the county and to collaborate with city health districts, private health care providers, medical facilities, behavioral facilities and members of the public.

The proposed changes haven’t been embraced by the local health commissioners.

“On paper it’s all OK,” said Dr. Jim Hubert, the health commissioner for Tuscarawas County. “You have to read between the lines.”

Hubert, who aids the county health department in serving a population of 92,000 people, said he fears a lack of local representation.

“We don’t have any idea of what will happen,” Hubert said. “That’s the issue.”

ASSOCIATION OF OHIO HEALTH COMMISSIONERS

Jennings said these reforms were based on a list of 11 recommendations presented by the Association of Ohio Health Commissioners.

Beth Bickford disagrees with that statement. The executive director for the Association of Ohio Health Commissioners, Bickford said the association’s recommendations were not used in Kasich’s proposals.

“Many of the proposals are either completely contrary to what those two reports suggested or weren’t even discussed,” she said.

When it came to grants, the committee proposed combining several categories of grants such as making a large grant that would cover diabetes, obesity and tobacco, Bickford said. Instead, the budget calls for health districts to share those grants and individual hubs to disburse the funding.

Bickford said problems could arise from both a funding standpoint — additional administrative fees taking away from dollars granted — and geography. She said programs may be made available to several counties but residents may have a long commute to get to the hub, or the health practitioners will have a long commute to dispense services.

“We’ve seen how this works in other grant programs. They’ve started to regionalize in this way and it really does result in service gaps,” she said.

Another issue she has is accreditation, saying Ohio would be the first to mandate it. “Cost of application fees alone is $2.3 million, a costly venture. That doesn’t include all the work to get ready.”

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Overall, accreditation is expected to cost the health departments $5 to $7 million for the process.

While she believes all 125 county and city health departments will be impacted if the current budget is passed as proposed, Bickford believes smaller health departments will be hurt the most.

CONSOLIDATION?

Dr. D.J. McFadden, the Holmes County Health Commissioner, also was involved in the association’s discussions that took place last year.

After reviewing the proposed changes, McFadden said consolidation of smaller health departments appears to be the next step.

“This is the logical downstream effect,” he said.

Jennings said consolidation isn’t the overall goal of the proposals, but might be a possibility.

“These proposed changes do not require consolidation, but they do require that each local health department seriously consider whether or not it has the foundational capabilities to provide core public health services and, if not, to identify how it will gain access to those capabilities, either directly, through cross-jurisdictional sharing, or consolidation,” Jennings said.

Due to the cuts in health department funding, the imposed fees of accreditation, and required sharing of services, McFadden said smaller health departments will suffer and likely be pushed to consolidate.

McFadden said it appears the budget is trying to make public health less expensive and more efficient. He said public health is inexpensive. “We’re the lowest cost in health care and have the highest impact.

“My concern is that there’s a big difference between efficient and effective and I think what people in the community want is public health that works. They want to know the water is clean, food is safe to eat, children are protected from infectious disease through vaccination,” he said.

Overall, McFadden believes Kasich is trying to eliminate local representation not just in health departments but several other areas as well.